Cary Gross

Cary Gross
Yale University | YU · Department of Internal Medicine

MD

About

701
Publications
42,410
Reads
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23,226
Citations
Citations since 2017
274 Research Items
12399 Citations
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Additional affiliations
January 1999 - December 2014
Yale University Tweets @cpgYale
Position
  • Professor of Medicine and Epidemiology

Publications

Publications (701)
Article
Importance The introduction of immune checkpoint inhibitors (ICIs) has transformed the care of advanced non–small cell lung cancer (NSCLC). Although clinical trials suggest substantial survival benefits, it is unclear how outcomes have changed in clinical practice. Objective To assess temporal trends in ICI use and survival among patients with adv...
Article
Full-text available
Objective To develop a measure for fair inclusion in pivotal trials by assessing transparency and representation of enrolled women, older adults (aged 65 years and older), and racially and ethnically minoritized patients. Design Retrospective cross sectional study. Population Sponsors of novel oncology therapeutics that were approved by the US Fo...
Article
Purpose: Rates of BRCA1 and BRCA2 prevalence among women with breast cancer vary by age, hormone receptor status, and family history. Recommendations for genetic testing have varied between overlapping guidelines, payor coverage policies, and have evolved over time, resulting in unclear implications for adoption into routine breast cancer care. M...
Article
PURPOSE Older women with high-risk early breast cancer (EBC) benefit from adjuvant chemotherapy, but their treatment is frequently complicated by toxic side effects, resulting in dose reductions and delays. This makes it challenging for oncologists to maintain a relative dose intensity (RDI) ≥ 85%, as recommended for optimal curative-intent treatme...
Article
Importance: Previous studies have demonstrated racial and ethnic inequities in medical student assessments, awards, and faculty promotions at academic medical centers. Few data exist about similar racial and ethnic disparities at the level of graduate medical education. Objective: To examine the association between race and ethnicity and perform...
Article
PURPOSE New therapies including oral anticancer agents (OAAs) have improved outcomes for patients with metastatic renal cell carcinoma (mRCC). However, little is known about the quality of end-of-life (EOL) care and systemic therapy use at EOL in patients receiving OAAs or with mRCC. METHODS We retrospectively analyzed EOL care for decedents with...
Article
Importance: Contemporary approaches to artificial intelligence (AI) based on deep learning have generated interest in the application of AI to breast cancer screening (BCS). The US Food and Drug Administration (FDA) has approved several next-generation AI products indicated for BCS in recent years; however, questions regarding their accuracy, appr...
Article
Objectives Distant metastases (DM) are the primary driver of mortality for patients with early stage non-small cell lung cancer (NSCLC) receiving stereotactic body radiation therapy (SBRT), yet patient-level risk is difficult to predict. We developed and validated a model to predict individualized risk of DM in this population. Methods We utilized...
Article
This cohort study evaluates the rate of systemic anticancer therapy use among patients dying of cancer.
Article
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Background The complex relationship between incarceration and cancer survival has not been thoroughly evaluated. We assessed whether cancer diagnosis during incarceration or the immediate post-release period is associated with higher rates of mortality compared with those never incarcerated. Methods We conducted a population-based study using a st...
Article
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Although lung cancer screening (LCS) with low dose computed tomography has been shown to reduce lung cancer mortality, benefits and harms of screening vary among eligible adults. The goal of this study was to evaluate whether LCS is more commonly used among populations most likely to benefit, namely adults with high lung cancer risk and low comorbi...
Article
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Although national guidelines recommend lung cancer screening for adults at high risk, only a small proportion of eligible adults in the US have been screened. The goal of this study was to understand barriers to screening among a specific but important population: patients who have been referred for screening, but who have not completed the test. W...
Article
Objective To examine real-world adherence to oral anticancer agents (OAAs) and its association with outcomes among Medicare beneficiaries with metastatic renal cell carcinoma (mRCC). Methods SEER-Medicare retrospective cohort study of patients with metastatic renal cell carcinoma (mRCC) who received an OAA between 2007 and 2015. We examined A) adh...
Article
Outcomes 1. Understand the landscape of end-of-life care quality measurement for children with serious illness 2. Discuss a unique research study that sought to establish parent priorities for end-of-life care quality measurement for children with cancer 3. Place study findings in a context of existing literature and future steps Importance Robust...
Article
Purpose: To examine demographic characteristics of matriculants to U.S. MD-PhD programs by sex and race/ethnicity from academic years (AYs) 2009-2018 and explore the relationships between trends in the percentage of female and underrepresented minority (URM) matriculants to programs with and without Medical Scientist Training Program (MSTP) fundin...
Article
Outcomes 1. Describe the landscape of end-of-life care quality measurement for children with serious illness 2. Discuss a unique research study that sought to establish parent priorities for end-of-life care quality measurement in children with cancer 3. Place study findings in a context of existing literature and future steps Original Research Ba...
Article
Importance: The federal Hospital Price Transparency final rule, which became effective in 2021, requires hospitals to publicly disclose payer-specific prices for drugs. However, little is known about hospital markup prices for parenterally administered therapies. Objective: To assess the extent of price markup by hospitals on parenterally admini...
Article
Purpose In an era of rapid expansion of FDA approvals for oral anticancer agents (OAAs), it is important to understand the factors associated with survival among real-world populations, which include groups not well-represented in pivotal clinical trials of OAAs, such as the elderly, racial minorities, and medically complex patients. Our objective...
Article
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Objectives The COVID-19 pandemic necessitates time-sensitive policy and implementation decisions regarding new therapies in the face of uncertainty. This study aimed to quantify consequences of approving therapies or pursuing further research: immediate approval, use only in research, approval with research (eg, emergency use authorization), or rej...
Preprint
Full-text available
Objectives The COVID-19 pandemic necessitates time-sensitive policy and implementation decisions regarding new therapies in the face of uncertainty. The aim of this study was to quantify consequences of approving therapies or pursuing further research: either immediate approval, use only in research, approval with research (e.g., Emergency Use Auth...
Article
Background: Unlike fee-for-service Medicare, the Veterans Health Administration (VHA) allows for the provision of concurrent care, incorporating cancer treatment while in hospice. Methods: We compared trends of aggressive care at end of life between Medicare and VHA decedents with advanced nonsmall cell lung cancer from 2006 to 2012, and the relati...
Article
Importance: Digital breast tomosynthesis (DBT) is a breast cancer screening modality that has gained popularity in recent years. Although insurance coverage for DBT is not mandated under the Patient Protection and Affordable Care Act, several states have required coverage without cost sharing for private insurers. Objective: To evaluate the asso...
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Background Despite no proven benefit in clinical outcomes, perioperative magnetic resonance imaging (MRI) was rapidly adopted into breast cancer care in the 2000’s, offering a prime opportunity for assessing factors influencing overutilization of unproven technology. Objectives To examine variation among physician patient-sharing networks in their...
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High-volume hospitals have been associated to better outcomes for high-risk cancer surgeries. However, there are concerns about inequitable access to high-volume hospitals. We assessed tendencies in access to high-volume hospitals for four (lung, pancreatic, rectal, esophageal) high-risk cancer surgeries for Black and Hispanic patients in the Natio...
Article
Importance: Racial disparity in the use of prostate magnetic resonance imaging (MRI) presents obstacles to closing gaps in prostate cancer diagnosis, treatment, and outcome. Objective: To identify clinical, sociodemographic, and structural processes underlying racial disparity in the use of prostate MRI among men with a new diagnosis of prostate...
Article
Background: Following a 2014 safety warning (that laparoscopic power morcellation may increase tumor dissemination if patients have occult uterine cancer), hysterectomy practice shifted from laparoscopic to abdominal approach. This avoided morcellating occult cancer, but increased perioperative complications. To inform the national impact of this...
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Background Limited and conflicting findings have been reported regarding the association between social support and colorectal cancer (CRC) outcomes. We sought to assess the influences of marital status and living arrangement on survival outcomes among patients with stage III colon cancer. Patients and Methods We conducted a secondary analysis of...
Article
Introduction: Oral anti-neoplastic agents (OAAs) for metastatic renal cell carcinoma (mRCC) are associated with increased cancer-specific survival. However, racial disparities in survival persist and older adults have the lowest rates of cancer-specific survival. Research from other cancers demonstrates specialty access is associated with high-qua...
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Background Older adults (≥65 years) with gastrointestinal (GI) cancers who receive chemotherapy are at increased risk of hospitalization caused by treatment-related toxicity. Geriatric assessment (GA) has been previously shown to predict risk of toxicity in older adults undergoing chemotherapy. However, studies incorporating the GA specifically in...
Article
PURPOSE Current tools in predicting survival outcomes for patients with colon cancer predominantly rely on clinical and pathologic characteristics, but increasing evidence suggests that diet and lifestyle habits are associated with patient outcomes and should be considered to enhance model accuracy. METHODS Using an adjuvant chemotherapy trial for...
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Importance Disadvantaged neighborhood-level and individual-level socioeconomic status (SES) have each been associated with suboptimal cancer care and inferior outcomes. However, independent or synergistic associations between neighborhood and individual socioeconomic disadvantage have not been fully examined, and prior studies using simplistic neig...
Article
Background: The COVID-19 pandemic has led to delays in patients seeking care for life-threatening conditions; however, its impact on treatment patterns for patients with metastatic cancer is unknown. We assessed the COVID-19 pandemic's impact on time to treatment initiation and treatment selection for patients newly diagnosed with metastatic solid...
Article
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Background First-line treatment with nivolumab plus ipilimumab (N+I) or nivolumab plus ipilimumab with two cycles of chemotherapy (N+I+chemotherapy) improve overall survival and progression-free survival for patients with metastatic non-small cell lung cancer (NSCLC), yet researchers have not concomitantly compared the cost-effectiveness of N+I and...
Article
Importance In April 2017, the US Preventive Services Task Force (USPSTF) published a draft guideline that reversed its 2012 guidance advising against prostate-specific antigen (PSA)–based screening for prostate cancer in all men (grade D), instead endorsing individual decision-making for men aged 55 to 69 years (grade C). Objective To evaluate cha...
Article
Importance Immune checkpoint inhibitors (ICIs) are part of standard of care for patients with many advanced solid tumors. Patients with poor performance status or organ dysfunction are traditionally ineligible to partake in pivotal randomized clinical trials of ICIs. Objective To assess ICI use and survival outcomes among patients with advanced ca...
Article
PURPOSE There are no existing quality measures (QMs) to optimize end-of-life care for children with cancer. Previously, we developed a set of 26 candidate QMs. Our primary objective in this study was to achieve stakeholder consensus on priority measures. METHODS We conducted an iterative, cross-sectional electronic survey, using a modified Delphi...
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Importance: The clinical decisions that arise from prostate magnetic resonance imaging (MRI) and genomic testing in patients with prostate cancer are not well understood. Objective: To evaluate the association between regional uptake of prostate MRI and genomic testing and observation vs treatment for prostate cancer. Design, setting, and parti...
Article
Background Digital breast tomosynthesis (DBT) has become a prevalent mode of breast cancer screening in recent years. Although older women are commonly screened for breast cancer, little is known about screening outcomes using DBT among older women.Objective To assess proximal screening outcomes with DBT compared to traditional two-dimensional(2-D)...
Preprint
Full-text available
Background: The COVID-19 pandemic has led to delays in patients seeking care for life-threatening conditions; however, its impact on treatment patterns for patients with metastatic cancer is unknown. We assessed the impact of the COVID-19 pandemic on time to treatment initiation (TTI) and treatment selection for patients newly diagnosed with metast...
Preprint
Full-text available
Background: The impact and value of clinical trial data sharing, including the number and quality of publications that result from shared data — shared data publications — may differ depending on the data sharing model used. Methods: We characterized the outcomes associated with two data sharing models previously used by Institutes of the U.S. Nati...
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Background Improving oral anticancer agent (OAA) initiation and adherence is the important quality-of-care issues, particularly since one fourth of anticancer agents being developed will be administered orally. Our objective was to identify provider- and patient-level characteristics associated with OAA initiation and adherence among individuals wi...
Article
Objectives: Post-operative radiation therapy (PORT) in locally advanced non-small cell lung cancer (LA-NSCLC) has historically been associated with toxicity. Conformal techniques like intensity modulated radiation therapy (IMRT) have the potential to reduce acute and long-term toxicity from radiation therapy. Among patients receiving PORT for LA-N...
Article
Over the past decade, screening mammography in the US has undergone notable technological change, as digital breast tomosynthesis (DBT) has replaced 2-dimensional (2D) mammography.¹ Although DBT is more expensive than 2D mammography, DBT may generate downstream savings by reducing the number of women called back for additional imaging.² The goal of...
Article
Background/Aims Over the past decade, numerous data sharing platforms have been launched, providing access to de-identified individual patient-level data and supporting documentation. We evaluated the characteristics of prominent clinical data sharing platforms, including types of studies listed as available for request, data requests received, and...
Article
PURPOSE Acute care imposes a significant burden on patients and cancer care costs. We examined whether an advanced practice provider-driven, cancer-specific urgent care center embedded within a large tertiary academic center decreased acute care use among oncology patients on active therapy. MATERIALS AND METHODS We conducted a quasi-experimental...
Article
Objective To examine the associations of primary care physician (PCP) care continuity with cancer-specific survival and end-of-life care intensity. Data Sources Surveillance, Epidemiology, and End Results linked to Medicare claims data from 2001–2015. Study Design Cox proportional hazards models with mixed effects and hierarchical generalized log...
Conference Paper
Hazard Ratios (95% CI) of Overall Mortality by Comparing Early-onset and Later-onset CRCAgeUnadjustedAdjusted for Stage OnlyFully Adjusted except StageFully Adjusted<501.04 (1.02-1.05)0.89 (0.88-0.90)1.02 (1.00-1.03)0.95 (0.93-0.96)51 - 551.001.001.001.00<200.83 (0.71-0.97)1.08 (0.93-1.26)1.05 (0.90-1.23)1.04 (0.88-1.22)20 - 241.04 (0.95-1.14)1.08...
Chapter
Thousands of older women diagnosed with early-stage breast cancer receive adjuvant radiation treatment therapy that can be safely omitted. The decision to undergo radiation treatment therapy is based upon several factors unique to the individual. Understanding the patient-specific relative risk and benefit of radiation therapy—and making the right...
Article
STUDY OBJECTIVE: To examine the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identify factors associated with missed diagnosis, and compare outcomes of patients who had preoperative versus missed diagnosis. DESIGN: Retrospective cohort study using linked data from the N...
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Full-text available
Objectives To examine company characteristics associated with better transparency and to apply a tool used to measure and improve clinical trial transparency among large companies and drugs, to smaller companies and biologics. Design Cross-sectional descriptive analysis. Setting and participants Novel drugs and biologics Food and Drug Administrat...
Article
Objectives: Racial disparities in cancer care and outcomes remain a societal challenge. Medicaid expansion through the Affordable Care Act was intended to improve health care access and equity. This study aimed to assess whether state Medicaid expansions were associated with a reduction in racial disparities in timely treatment among patients diag...
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Objectives: To examine whether the case fatality rate (CFR) of coronavirus disease 2019 (Covid-19) decreased overtime, and whether the Covid-19 testing rate is a driving factor for the changes if the CFR decreased. Methods: Analyzing Covid-19 cases, deaths, and tests in Ontario, Canada, we compared the CFR between the first wave and the second w...
Article
Background To increase diversity and inclusion in graduate medical education, the Accreditation Council for Graduate Medical Education (ACGME) issued a revision to their Common Program Requirements during the 2019–2020 academic year mandating that all residency programs must have policies and practices to achieve appropriate diversity among trainee...
Article
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Importance While increased adherence to colorectal cancer (CRC) screening guidelines in the US has been associated with significant reductions in cancer incidence in US individuals aged 50 years and older, the incidence of CRC among those aged younger than 50 years has been steadily increasing. Understanding the survival among individuals with earl...
Article
Thyroid cancer is among the most common malignancies in the US, with a 3.6% annual increase in incidence over the past 50 years.¹ Treatment regimens for thyroid cancer are well-established, with excellent survival outcomes. However, costs of thyroid cancer care can vary substantially by hospital and impose significant financial burdens on patients²...
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Importance: Clinical research supporting US Food and Drug Administration (FDA) drug approvals is largely conducted outside the US. Objective: To characterize where drugs were tested for FDA approval and to determine how commonly and quickly these drugs received marketing approval in the countries where they were tested, both overall and by count...
Article
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Importance Adequate representation of demographic subgroups in premarketing and postmarketing clinical studies is necessary for understanding the safety and efficacy associated with novel cancer therapeutics. Objective To characterize and compare the reporting of demographic data and the representation of individuals by sex, age, and race in prema...
Article
Background: Digital breast tomosynthesis (DBT) may have a higher cancer detection rate and lower recall compared to 2 D mammography for breast cancer screening. The goal of this study was to evaluate screening outcomes with DBT in a real-world cohort, and to characterize the population health impact of DBT as it is widely adopted. Methods: This...
Article
Full-text available
PurposeTo evaluate practice patterns of planned post-operative radiation therapy (RT) among men with positive surgical margins (PSM) at radical prostatectomy.Methods We identified 43,806 men within the National Cancer Database with pathologic node-negative prostate cancer diagnosed in 2010 through 2014 with PSM. The primary endpoint was receipt of...
Conference Paper
Background: Physical resilience, the ability to resist decline and maintain functional status despite a stressor such as chemotherapy, is a central aspect of successful aging. Understanding clinical and biological factors associated with resilience in older women receiving chemotherapy for early breast cancer may facilitate the development of targe...
Article
Background: Breast cancer screening for women aged 40-49 years is prevalent and costly, with costs varying substantially across US regions. Newer approaches to mammography may improve cancer detection but also increase screening costs. We assessed factors associated with regional variation in screening costs. Methods: We used Blue Cross Blue Shi...
Article
Full-text available
Importance: Medical trainee burnout is associated with poor quality care and attrition. Medical students in sexual minority groups report fear of discrimination and increased mistreatment, but the association between sexual orientation, burnout, and mistreatment is unknown. Objective: To evaluate whether medical student burnout differs by sexual...
Article
Context Among adults with cancer, measures for high quality end-of-life care (EOLC) include avoidance of hospitalizations near end of life. For children with cancer, no measures exist to evaluate or improve EOLC, and adult quality measures may not apply. Objective We engaged key stakeholders to explore EOLC priorities for children with cancer and...
Article
Full-text available
Introduction Patients with early-stage non-small cell lung cancer (NSCLC) commonly must choose between a surgery with superior local control (lobectomy) or one that preserves lung parenchyma (wedge). Recognizing that many cancer patients have competing mortality risks unrelated to cancer, we investigated whether an established model of predicting l...
Article
PURPOSE Limited tools exist to predict the risk of chemotherapy toxicity in older adults with early-stage breast cancer. METHODS Patients of age ≥ 65 years with stage I-III breast cancer from 16 institutions treated with neoadjuvant or adjuvant chemotherapy were prospectively evaluated for geriatric and clinical features predictive of grade 3-5 ch...
Article
PURPOSE Hospital at home (HaH) is a means of providing inpatient-level care at home. Selection of admissions potentially suitable for HaH in oncology is not well studied. We sought to create a predictive model for identifying admissions of patients with cancer, specifically solid-tumor malignancies, potentially suitable for HaH. METHODS In this ob...
Article
Background Trauma-related disorders rank among the top five most costly medical conditions to the health care system. However, the impact of out-of-pocket (OOP) health expenses for traumatic conditions is not known. In this cross-sectional study, we use nationally representative data to investigate whether patients with a traumatic injury experienc...
Article
BACKGROUND Safety warnings about power morcellation in 2014 considerably changed hysterectomy practice, especially for laparoscopic supracervical hysterectomy that typically requires morcellation to remove the corpus uteri while preserving the cervix. Hospitals might vary in how they responded to the safety warnings and altered hysterectomy procedu...
Article
Importance Although tissue-based genomic tests can aid in treatment decision-making for patients with prostate cancer, little is known about their clinical adoption. Objective To evaluate regional adoption of genomic testing for prostate cancer and understand common trajectories of uptake shared by regions. Design, Setting, and Participants This...
Article
Study Objective Preoperative detection of uterine leiomyosarcoma is important in hysterectomies performed for presumed benign indications. This study examined the effectiveness of endometrial sampling for preoperative diagnosis of leiomyosarcoma and the factors associated with a false negative. Design This is a retrospective analysis of linked dat...